Broken Bone Research Paper

Throughout childhood and into adolescence having skinned up knees and injuries was all part of growing up. If we fell and injured ourselves, we would get right back up and move on with our lives. In some cases children may view having a broken bone as a source of pride. However for older adults the dangers of falling have real consequences because if a bone is broken it can range anywhere from a temporary inconvenience to a complete loss of independence. The elderly also have a higher chance of breaking bones when they fall due to bone loss and osteoporosis. When a person falls one of the only ways to check the extent of their injuries is through professional assessment and radiographs. Such as the instance when an elderly 65 year
old male was admitted into Christus Sphon South emergency room department for radiographs due to a fall. When he fell he injured his right shoulder and was experiencing pain in both his back and shoulder. Upon entering his room I verified his identity by checking his name, date of birth and the account number on his armband. In addition to verifying his identity, I also obtained a brief history of why he was there. He was in good general health and did not have a history of falling, but on that particular day he was walking outside and stumbled over his flip flops. I obtained his permission to take radiographs and transported him into the radiology department. After I brought him into the radiograph room by wheelchair, I checked with him if he felt okay to stand.
He said he felt fine to stand, but he just needed help to get up. His diagnostic order was for a 2 view chest x-ray and a 4 view right shoulder x-ray. I started with a PA chest followed by a left lateral x-ray. First, I placed a 14 x 17 crosswise digital image cassette into the upright bucky and moved the x-ray tube to a 72 inch SID with the tube head at a 90 degree angle. The exposure was set for 110 kV with 15 mAs and used my left image marker. I then assisted the patient into an erect position asked him to stand with his feet slightly apart facing the upright bucky. In order to insure proper central ray and image receptor alignment I measured with my fingers approximately 8 inches down from his vertebral prominence at the midsagittal plane of his spine. I asked him to roll his shoulders forward and ensured that there was no rotation of his body and that his chin was raised before making the exposure. When making the exposure I asked him to take in 2 full deep breaths and on the last breath to hold it in. The x-ray showed both lungs centered on the radiograph and included the clavicles and diaphragm. The lung apices as well and the costophrenic angles were well demonstrated along with his ribs, heart, and hilum
markings. After taking the PA chest radiograph I asked the patient to move so that his left side of his body was touching the upright bucky. Before positing the patient I removed the image cassette and changed it into a lengthwise position and moved my left image marker so it would be in the collimated light field. I then asked the patient to raise his hands above his head and to keep his elbows in with his hands resting on top of his head. I ensured that there was no rotation of his body by checking the alignment of his scapulae and verified that the central ray was centered to his midthorax and at the level of his 7th thoracic vertebra. The exposure was taken using 110 kVp with 25 mAs on the second full inspiration. The radiograph showed his entire lungs, including the apices and posterior costophrenic angles. Also his heart, lung markings and diaphragm were visualized. The technologist I was working with then took over for the shoulder radiographs.
He had the patient stand with his right shoulder against the center of the bucky for an AP projection of his right humerus. The technologist took both external and internal rotation projections. For the external rotation of the humerus the patient slightly abducted his arm and rotated it externally. The central ray was placed 1 inch inferior to his coracoid process. For the internal rotation the patient kept his arm slightly abducted and rotated his arm internally and the central ray was kept in the same location. In the radiographs you were able to identify the clavicle and scapula along with the greater and lesser tubercle. Also the head and proximal end of the humerus and the coracoid process were visualized. Both exposures were taken using a 40 inch SID with 70 kVp and 25 mAs. The patient was asked to hold their breath and not to move during exposure. A lengthwise 14 x 17 digital image cassette was used and collimated down on all four sides to the soft tissue
margins. Next a grashey posterior oblique x-ray of the right shoulder was performed. The bucky was adjusted so the cassette was approximately 2 inches above his shoulder. The patient was kept in the erect position with his shoulder touching the bucky and his body was rotated 35 degrees to the right. His arm was slightly abducted and the central ray was centered to his scapulohumeral joint. The light was collimated down to the soft tissue margins and the exposure was taken using 70 kVp with 25 mAs and 40 inch SID. The radiograph showed the glenoid cavity, coracoid process, the head of the humerus and the scapulohumeral joint. The final part of the exam was a lateral Scapular Y radiograph. The patient was moved into an anterior oblique position with his right shoulder touching the bucky. His left arm was moved to insure it did not interfere with the anatomy and the central ray was centered to his scapulohumeral joint. The exposure was taken using 70 kVP with 50 mAs and a 40 inch SID. The patent was instructed to hold their breath and not to move during the exposure. In the radiograph you were able to visualize the clavicle, acromion, coracoid process and the head of the humerus. The body of the scapula and the humerus were also demonstrated. In the radiograph you could see that the coracoid process and the acromion appeared as a letter Y. After the radiographic examination was concluded I helped the patient back into the wheel chair and returned him to his room in the emergency department. I was later able to look up the results of his radiograph. His chest radiograph showed that his cardiac size was not enlarged and that there was a slight wedging of one of the midthoracic vertebral bodies that correlate with mild back pain. His shoulder radiographs showed that the alignment was normal and no fracture was apparent. Some arthritic change was noted in the shoulder joint and the aromioclavicular joint.
Many falls do not cause injuries, however this is not always the case. Fortunately for this patient the results of his radiograph were good and he was able to go home. When a fall results in broken bones for the elderly they can make it hard for them to get around and do everyday activities or even live on their own. If a person of any age young or old falls and is experiencing pain they should seek professional help to have it assessed for fractures or broken bones.